What is a fall prevention program?

A falls prevention program is defined as:

An evidence-based program that systematically identifies potential risks (environmental, pharmacological, morbidities, etc.) and provides targeted intervention to lower the falls per capita rate within a population. 

Fall prevention programs are typically carried out in locations that are exclusive to older adults (65+), such as senior centers and assisted living facilities and the benefits of fall prevention program can have a drastic impact on your residents including:

• Improving motor skills
• Diminishing the risk of falls
• Delaying elements of deterioration related to aging
• Increasing social skills and networks

Standard fall prevention programs

There are three sets of activities within a typical fall prevention program. The first activity is to look at the overall environment and eliminate potential tripping or slipping hazards. Elimination can include adding more lighting, ensuring appropriate handrails at all stair locations, using low-pile rugs, providing wide aisleways, etc. This can be instituted in the home and within a community living environment. 

The second activity is to review the risks at the individual level. This can include ensuring prescriptions for glasses are up to date, medications are reviewed for possible cognitive or physical side effects, and periodically evaluate any vestibular or neurological issues that they may be experiencing. 

The third activity is targeted interventions to prevent falls.

What are interventions to prevent falls?

Targeted intervention can include physical therapy, where the older adult receives one-on-one therapy from a licensed physical therapist for a limited duration (typically 12-15 sessions). Physical therapy sessions are often covered by insurance or Medicare, but those programs will typically limit the amount of physical therapy an older adult can receive in a calendar year. Targeted intervention can also include less intense group programs or classes, such as Otago, Tai Chi, and Bingocize. The cost of these programs is sometimes covered by the Medicare Advantage (itself or through Silver Sneakers), sometimes by the senior living community, and sometimes by the individual.

How can we improve fall prevention?

Industry surveys suggest that up to 75% of senior living communities have implemented some type of fall prevention programs for the elderly. When you also include fall prevention programs available through senior centers and other community organizations, a significant proportion of older adults in the United States have access to the benefits of fall prevention programs. 

Unfortunately, there is evidence that this explosive growth in fall prevention programs have not been effective in reversing the epidemic of falls among older adults. 

Data published by the Centers for Disease Control (CDC) shows the fall death rate among adults age 65 and older increased 40% between 2007 and 2018, reaching 64 per 100,000 (and, as discussed earlier, this is likely a conservative estimate). Even though more recent data has suggested that the fall rate is stabilizing, there are clearly opportunities for improvement. 

Effectiveness of fall prevention programs

Almost all the benefits of fall-prevention programs are evidence-based, meaning there are studies demonstrating effectiveness. But, peer-reviewed papers often described fall prevention programs as only modestly effective or even ineffective. So, what’s missing?

Discussions with leading researchers and practitioners identified five key issues with current fall prevention programs

• Fall prevention programs are typically reactive, initiating once someone is identified as a fall risk, even though 50 to 75% of first-time fallers were never identified as a risk
• Current fall prevention interventions force participants to choose between short-term individualized therapy provided by a skilled physical therapist or longer-term wellness activity provided in a group setting. Neither arrangement is optimum in preventing falls over a large population
• Overemphasis on environmental mitigation and physical exercise without addressing the role of executive function in balance and gait
• Adherence rates are relatively low, especially for those interventions that may take several months to show demonstrable effects
• Most studies demonstrate a limited efficacy, with up to 30 to 50% reduction in falls.